Laboratory Fee Schedule - Maine.gov
Laboratory Fee Schedule - Maine.gov
Laboratory Fee Schedule - Maine.gov
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Procedure<br />
Code<br />
<strong>Laboratory</strong> <strong>Fee</strong> <strong>Schedule</strong><br />
Effective January 1, 2013<br />
Modifier Code Description Rate<br />
87476 iadna borrelia burgdorferi amplified probe tq $12.00<br />
87477 iadna borrelia burgdorferi quantification $13.00<br />
87480 iadna candida species direct probe tq $14.85<br />
87481 iadna candida species amplified probe tq $12.00<br />
87482 iadna candida species quantification $13.00<br />
87485 iadna chlamydia pneumoniae direct probe tq $14.85<br />
87486 iadna chlamydia pneumoniae amplified probe tq $12.00<br />
87487 iadna chlamydia pneumoniae quantification $13.00<br />
87490 iadna chlamydia trachomatis direct probe tq $14.85<br />
87491 iadna chlamydia trachomatis amplified probe tq $19.29<br />
87492 iadna chlamydia trachomatis quantification $13.00<br />
87493 inf agent det nucleic acid clostridium amp probe $35.81<br />
87495 iadna cytomegalovirus direct probe tq $8.00<br />
87496 iadna cytomegalovirus amplified probe tq $12.00<br />
87497 iadna cytomegalovirus quantification $13.00<br />
87498 iadna enterovirus amplif probe & revrse trnscrip $35.81<br />
87500 infectious agent dna/rna vancomycin resistance $35.81<br />
87501 infectious agent dna/rna influenza ea type $41.48<br />
87502 infectious agent dna/rna influenza 1st 2 types $77.26<br />
87503 nfct agent dna/rna influenza 1/>types ea addl $13.44<br />
87510 iadna gardnerella vaginalis direct probe tq $14.85<br />
87511 iadna gardnerella vaginalis amplified probe tq $12.00<br />
87512 iadna gardnerella vaginalis quantification $13.00<br />
87515 iadna hepatitis b virus direct probe technique $8.50<br />
87516 iadna hepatitis b virus amplified probe tq $12.00<br />
87517 iadna hepatitis b virus quantification $13.00<br />
87520 iadna hepatitis c direct probe technique $8.50<br />
87521 iadna hepatitis c amplified probe&revrse transcr $12.00<br />
87522 iadna hepatitis c quant & reverse transcription $13.00<br />
87525 iadna hepatitis g direct probe technique $8.50<br />
87526 iadna hepatitis g amplified probe technique $12.00<br />
87527 iadna hepatitis g quantification $13.00<br />
87528 iadna herpes simplx virus direct probe tq $8.50<br />
87529 iadna herpes somplx virus amplified probe tq $12.00<br />
87530 iadna herpes somplx virus quantification $13.00<br />
87531 iadna herpes virus-6 direct probe tq $8.50<br />
87532 iadna herpes virus-6 amplified probe tq $12.00<br />
87533 iadna herpes virus-6 quantification $13.00<br />
87534 iadna hiv-1 direct probe technique $8.50<br />
87535 iadna hiv-1 amplified probe & reverse transcrpj $12.00<br />
87536 iadna hiv-1 quant & reverse transcription $77.24<br />
87537 iadna hiv-2 direct probe technique $8.50<br />
87538 iadna hiv-2 amplified probe & reverse transcripj $12.00<br />
87539 iadna hiv-2 quant & reverse transcription $13.00<br />
87540 iadna legionella pneumophila direct probe tq $8.50<br />
87541 iadna legionella pneumophila amplified probe tq $12.00<br />
87542 iadna legionella pneumophila quantification $13.00<br />
Fac/Non-<br />
Facility